title: Portal hypertensive enteropathy diagnosed by capsule endoscopy and demonstration of the ileal changes after transjugular intrahepatic portosystemic shunt placement: a case report.
abstract: BACKGROUND
  Recent data suggest that mucosal abnormalities can occur even in the duodenum, jejunum, and distal ileum of cirrhosis patients. We present a case of portal hypertensive enteropathy in a cirrhosis patient shown by capsule endoscopy and the effect of transjugular intrahepatic portosystemic shunt on the ileal pictures.
  
  
  METHODS
  An 83-year-old Caucasian woman was admitted to our hospital for anemia and a positive fecal occult blood test. An upper gastrointestinal endoscopy revealed small varices without bleeding signs and hypertensive gastropathy. Colonoscopy was negative. To rule out any other cause of bleeding, capsule endoscopy was performed; capsule endoscopy revealed severe hyperemia of the jejunum-ileal mucosa with active bleeding. Because of the persistence of anemia and the frequent blood transfusions, not responding to β-blocker drugs or octreotide infusion, a transjugular intrahepatic portosystemic shunt was performed. Anemia improved quickly after the transjugular intrahepatic portosystemic shunt, and no further blood transfusion was necessary in the follow-up. The patient developed portal encephalopathy two months later and was readmitted to our department. We repeated the capsule endoscopy that showed a significant improvement of the gastric and ileal mucosa without any signs of bleeding.
  
  
  CONCLUSIONS
  Hypertensive enteropathy is a rare condition, but it seems more common with the introduction of capsule endoscopy in clinical practice. This case shows that the jejunum can be a source of bleeding in cirrhosis patients, and this is the first demonstration of its resolution after transjugular intrahepatic portosystemic shunt placement.
authors.affiliation: Department of Gastroenterology and GI Endoscopy, Arcispedale S,Anna, Corso Giovecca 203, 44100 Ferrara, Italy. a.pezzoli@ospfe.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pezzoli
authors.forename: Nadia
authors.initials: N
authors.lastname: Fusetti
authors.forename: Loredana
authors.initials: L
authors.lastname: Simone
authors.forename: Angelo
authors.initials: A
authors.lastname: Zelante
authors.forename: Viviana
authors.initials: V
authors.lastname: Cifalà
authors.forename: Alessandra
authors.initials: A
authors.lastname: Carella
authors.forename: Sergio
authors.initials: S
authors.lastname: Gullini